Harvest Senior Living #2

Type of visit: Required - 1 Year

At 9:00am, on 12/17/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator - Jennifer Miller, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility is a single story residential home with six private resident bedrooms, each bedroom has a full en suite bathroom. There is also a public half bathroom down the west hallway. There is a living room with seating, a TV, and credenza with games and puzzles. Near the living room is a dining space and a kitchen. Access to the laundry room is through a locked door for resident safety. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy. The facility has battery operated and wired smoke detectors in each room that are all working, the carbon monoxide detector is in the west hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 11/21/2025. LPA tested facility hot water at 105*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair with no obstructions in hallways, doorways or exits. Medications are locked in an office located in the east hallway. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 17, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 10:30am on 11/14/2024, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct the facility annual inspection. LPA met with Administrator, Jennifer Miller announced who he is and the reason for the visit. Administrator and LPA conducted a full tour of the facility, and facility grounds. The facility is located in a rural area on approximately two acres which is gated. The facility has 6 bedroom, and 6 bathrooms, of which one bathroom is a common shared bathroom for residents, staff and visitors. There is a laundry room which has a refrigerator, a closed hallway that has a sink and locked cabinets where chemicals are stored. Medications are located in a locked cabinet in the hallway. The kitchen dining room and living room are open concept configuration. There are dual smoke detectors/carbon monoxide detectors throughout the facility and a individual carbon monoxide detector in the west hallway all currently functional. Administrator and LPA reviewed emergency disaster plan, infection control plan and fire clearance review. LPA reviewed staff, and resident files and reviewed medication records including Centrally Stored Medication Records (CSMR) LPA observed all resident bedrooms and bathrooms all found to be compliant with regulation standards. LPA observed full facility and facility grounds and found all to be compliant with regulation standards. LPA noted that there is a complete first aide kit on hand at the facility in the hallway closet. LPA noted that the facility food supply that currently meets or exceeded licensing standards of perishable and non-perishable foods. LPA noted that the facility is clean and in good repair. LPA noted that all exits and hallways were free and clear from obstructions. Administrator and LPA conducted a full review of the care tools modules and discovered no issues, technical, violations, or citations. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

Type of visit: Prelicensing

At 10:00am on 12/16/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility at the schedule time to conduct the pre-licensing inspection of the facilities change of ownership (CHOW). LPA met with Administrator Jennifer Miller to conducted the pre-licensing inspection. Administrator and LPA conducted a full tour of the facility, and facility grounds. The facility is located in a rural area on approximately two acres which is gated. The facility has five bedroom, and 6 bathrooms, of which one bathroom is a common shared bathroom for residents, staff and visitors. There is a laundry room which has a refrigerator, a closed hallway that has a sink and locked cabinets where chemicals are stored. Medications are located in a locked cabinet in the kitchen island. The kitchen dining room and living room are open concept configuration. There are dual smoke detectors/carbon monoxide detectors throughout the facility and a individual carbon monoxide detector in the west hallway all currently functional. Administrator and LPA reviewed emergency disaster plan, infection control plan and fire clearance review. LPA noted that the facility has well water tank and passed regulatory inspection for initial licensing inspection. LPA observed all resident bedrooms and bathrooms all found to be compliant with regulation standards. LPA observed full facility and facility grounds and found all to be compliant with regulation standards. LPA noted that there is a complete first aide kit on hand at the facility. LPA noted that the facility food supply that currently meets or exceeded licensing standards of perishable and non-perishable foods. LPA noted that the facility is clean and in good repair. LPA noted that all exits and hallways were free and clear from obstructions. Administrator and LPA conducted a full review of the pre-licensing care tools modules and discovered no issues, technical, violations, or citations. LPA conducted the full Composition III (COMP III) review with Administrator Jennifer Miller. At this time the pre-licensing inspection and COMP III component has been completed and LPA Jeffries has no objections to the change of ownership (CHOW) licensing of this facility. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Dec 16, 2023

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 Method: Telephone call with CAB COMP II Participants: Jennifer Miller, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 11, 2023